Follow-up of infants born to mothers with autoinmune thyroid disease. What should not be screened? / Seguimiento del hijo de madre con patología tiroidea autoinmune. ¿Qué no debemos cribar?

INTRODUCTION: Thyroid dysfunction is a common problem in pregnant women. It is usually of an autoimmune origin, with Hashimotós thyroiditis and Graves disease being the most common conditions. Although hormonal changes and transplacental antibody transfer may occur, specific neonatal screening has not been shown to be useful. PATIENTS AND METHOD: A prospective study of newborns of women with autoimmune thyroid disease born at a level III university hospital (November 2013-December 2016). Neonates were selected during their stay at the maternity. Babies with perinatal asphyxia were excluded. Data were collected from the clinical histories of mothers and newborns. RESULTS: A total of 191 neonates were included. Ninety percent of mothers had been diagnosed with autoimmune hypothyroidism. Only 5.8% of newborns had some laboratory disorder, consisting of slightly increased thyroid-stimulating hormone levels, which returned to normal at the age of one month and did not correlate to thyroid peroxidase antibody levels. Transient hyperthyrotropinemia was diagnosed in one newborn and required thyroxin treatment during the first year of life. Among newborns from mothers with Graves disease, 36.8% had some abnormal laboratory value during the first 7 days of life, but there were no cases of hyperthyroidism and only one of transient hyperthyrotropinemia. CONCLUSIONS: Experience at our hospital in screening of newborns from hypothyroid mothers reveals a high number of laboratory controls with a poor diagnostic yield. No relationship was found between thyroid peroxidase antibody levels and thyroid dysfunction. We support the recommendations to continue testing serum thyroid-stimulating hormone and FT4 levels at 48h of life in newborns of mothers with autoimmune hypothyroidism.

[Study of anxiety levels in neonatal unit staff]. / Estudio de los niveles de ansiedad en los profesionales de una unidad neonatal.

INTRODUCTION: The professionals who routinely work in neonatal units become under stress due to the working conditions and the nature of the tasks carried out. As a consequence of this, they may have high levels of anxiety. Anxiety is defined as an emotional response or response patterns that include cognitive, physiological and behavioural aspects. METHODS: A prospective cross-sectional study was conducted on all neonatologist, nurses and care assistants who were given two self-administered questionnaires under baseline conditions, to assess Sate Anxiety and Trait Anxiety. (IDDA-EA; STAI, State-Trait Anxiety Inventory). RESULTS: The response rate was 88.5%, and 36% scored between 30 and 70 percentiles on State Anxiety, with 11.8% above the 70 percentile and 51% below the 30 percentile. There were no significant differences in relation to occupation or age. There were also no significant differences between State and Trait Anxiety. Regarding gender, it has obtained A statistically significant difference of 8 points higher was obtained for women. CONCLUSIONS: For the majority professionals everyday situations in which are involved do not significantly raise the burden of anxiety, as half of them have levels below the average. They perceive themselves as competent and able to cope with their tasks. They have a high degree of interest and attention in the activities performed.

Age of sitting unsupported and independent walking in very low birth weight preterm infants with normal motor development at 2 years.

AIMS: The aims of this study is to (i) determine the age of sitting unsupported and independent walking in preterm infants with birth weight under 1500 g (very low birth weight, VLBW); (ii) estimate differences between VLBW children and a reference population and (iii) estimate the association between clinical characteristics and late age at sitting and walking. METHODS: A longitudinal study was conducted of a cohort of 876 children with VLBW. The World Health Organization (WHO) motor development study population was used as a reference. Ages for both skills were established by interview with parents. Means were compared with t-test, ANOVA and Bonferroni adjustment where appropriate. RESULTS: The inclusion criteria were complied with 694 patients; 50% of VLBW sat at 7 m corrected age (CA) and walked at 13 m CA. Both motor skills were acquired later (7.3 +/- 1.5 and 13.6 +/- 2.8 m) compared with the control group (6 +/- 1.1 and 12.1 +/- 1.8 m). Weight or head circumference at birth below the 10th percentile or the presence of bronchopulmonary dysplasia were associated with delayed acquisition of both skills. CONCLUSION: Very low birth weight infants typically sit unsupported and walk later than term infants. Tables describing reference values for milestones acquisition for different categories of infants (gestational age, birth weight and other determinants) may contribute to inform the decision making process on access to available resources.

[Retinopathy of prematurity screening in Spanish neonatal units]. / Cribado de la retinopatía de la prematuridad en las unidades neonatales españolas.

INTRODUCTION: A wide variety of retinopathy of prematurity (ROP) screening criteria exists in the different hospitals. In 1988, the benefits of cryotherapy treatment in severe ROP cases were demonstrated, and since then, some scientific societies have made recommendations on the screening and treatment of ROP. Within the Spanish scientific community, there are no specific recommendations on screening, diagnosis or treatment. OBJECTIVES: To describe the criteria used in the screening of retinopathy in premature newborns by those Spanish hospitals caring for babies with birth weights below 1,500 g. MATERIAL AND METHOD: A cross-sectional study was performed based on a 50 question questionnaire on screening criteria and other related issues. This questionnaire was sent to those public and private neonatal units in Spain caring for babies with birth weights below 1,500 grams. The questionnaire was sent and returned between January 2002 and May 2003. RESULTS: Units in all of the 17 autonomous communities and both autonomous cities in territorial Spain (Ceuta and Melilla) responded. There was a 90% response rate. All the participating hospitals perform ROP screening. Only 62.9% of the hospitals follow a written protocol on screening. A large majority of hospitals (79.8%) perform a retinal eye examination on all newborns below 1500 g at birth. Half of the hospitals included in the study, 51.6%, determine the cut-off point for performing the screening at 32 weeks of gestational age. Around 73% of the hospitals include the administering of oxygen supplements to premature babies as part of the criteria for screening, regardless of the babies' weight and gestational age. Weight, gestational age and oxygen are the only criteria used in 51% of the units. That all hospitals in Spain should establish some screening criteria was suggested by 90% of the responses. Only 10% use analgesia or sedation, other than topical, when examining the retina. CONCLUSIONS: Even though all the hospitals participating in the study screen for ROP, there is little agreement on which criteria should be followed when screening and on other aspects related to its practice.

[Developmental centered care. Evaluation of Spanish neonatal units]. / Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España.

INTRODUCTION: Developmental and family centered care (DC) is a framework that aims to enhance the neurodevelopment of the infant. Over the last few years Spanish neonatal units have been working toward introducing this type of care. OBJECTIVE: To evaluate DC in Spanish neonatal units by assessing certain features of the care provided to very low birth weight infants and their families. MATERIAL AND METHOD: Spanish hospitals attending infants under 1,500 g were identified. A cross sectional study was performed using a telephone questionnaire with 25 DC-related items. RESULTS: Of the 100 hospitals attending infants under 1,500 g, 83 hospitals from all the Autonomous Communities in Spain participated in the survey. Of these, 31 % had noise pollution controls, 72 % controlled light intensity, 75 % bound the infants, and 29 % used saccharose as an analgesic. Ten percent allowed unrestricted parental visits. Twenty-two percent used kangaroo care without restriction. Sixty-three percent of the units reported difficulties when introducing DC-related changes. CONCLUSIONS: Practically all neonatal units have some type of DC activity, although in certain areas, such as unrestricted parental visits, the rate of implementation is low.